Department of Orthopaedics, University of Cincinnati, Cincinnati, Ohio, USA.
J Arthroplasty. 2013 Sep;28(8):1274-7. doi: 10.1016/j.arth.2013.03.008. Epub 2013 Apr 20.
Pain control is necessary for successful rehabilitation and outcome after total knee arthroplasty. Our goal was to compare the clinical efficacy of periarticular injections consisting of a long-acting local anesthetic (ropivacaine) and epinephrine with and without combinations of an α2-adrenergic agonist (clonidine) and/or a nonsteroidal anti-inflammatory agent (ketorolac). In a double-blinded controlled study, we randomized 160 patients undergoing total knee arthroplasty to receive 1 of 4 intraoperative periarticular injections: Group A, ropivacaine, epinephrine, ketorolac, and clonidine; Group B, ropivacaine, epinephrine, and ketorolac; Group C, ropivacaine, epinephrine, and clonidine; Group D (control), ropivacaine and epinephrine. Compared with Group D, Group A and B patients had significantly lower postoperative visual analog pain scores and nurse pain assessment and Group C patients had a significantly greater reduction in physical therapist pain assessment. We found no differences in other parameters analyzed.
疼痛控制对于全膝关节置换术后的成功康复和结果至关重要。我们的目标是比较关节周围注射长效局部麻醉剂（罗哌卡因）和肾上腺素，以及是否联合使用α2-肾上腺素能激动剂（可乐定）和/或非甾体抗炎药（酮咯酸）的临床疗效。在一项双盲对照研究中，我们将 160 例接受全膝关节置换术的患者随机分为 4 组接受术中关节周围注射：A 组，罗哌卡因、肾上腺素、酮咯酸和可乐定；B 组，罗哌卡因、肾上腺素和酮咯酸；C 组，罗哌卡因、肾上腺素和可乐定；D 组（对照组），罗哌卡因和肾上腺素。与 D 组相比，A 组和 B 组患者术后视觉模拟疼痛评分和护士疼痛评估明显较低，C 组患者物理治疗师疼痛评估明显降低。我们在分析的其他参数中未发现差异。
